This Is Why I Swore Off Stilettos

WHY YOU SHOULD CARE

Those too-tight shoes might cause you more grief than you think.

June 19, 2015

The pain it inflicts, ranging from tenderness to a burning, tingling sensation, doesn’t discriminate against age, sex or education level. It worsens overall physical health, mental health and the ability to function in social situations. And it plagues nearly:

The source of all this distress? None other than the sinister-sounding hallux valgus, aka bunions. Although few studies have probed the prevalence of the toe deformity over time, experts have still noticed some stark trends. Bunions tend to be more common among women, African-Americans and adults over 50 — and high heels and genetics are probably most to blame.

Bunions occur when the big toe gets shoved into the second toe, jutting the joint outward into a tough, painful knob. Doctors might recommend icing the big toe, pain meds, shoe inserts, splints or wider shoes. But these measures only slow the bunion’s inevitable progression. When the pain becomes too much to bear, people usually resort to surgery.

Gary Pichney, a podiatric surgeon at Mercy Medical Center in Baltimore, has noticed more of his patients requesting bunion surgery in recent years, mainly because it’s become more effective. Decades ago, surgeons shaved off the bunion in a quick “lunchtime bunionectomy” — but it would often grow back. Now, they make cuts into the bone and insert screws to actually realign the joint.

Skinny heels can pinch toes together, possibly explaining why 90 percent of bunions occur in women. But shoes don’t tell the whole story. Research suggests that bunions run in families, and could be linked to knee or hip osteoarthritis, also heritable conditions, according to the 2012 Johnston County Osteoarthritic Project. Genetics are “pretty much your greatest risk factor,” Pichney says. But Yvonne Golightly, an epidemiologist at the University of North Carolina School of Medicine — who led the Johnston study — thinks “shoe wear is what matters the most.” She recommends shoes that don’t have a high heel or that offer adequate toe room.

Flat feet are a risk factor too, since their loose ligaments make them more likely to roll inward. So is age: A 2011 study found that about 28 percent of participants aged 50 to 59 reported having bunions, compared with about 56 percent of those over 80. Additionally, the Johnston study revealed that blacks were twice as likely as whites to suffer from bunions. They were also significantly more likely to develop hammer toes and overlapping toes — although it’s still not clear why.

Sure, they might cause blisters and ingrown toenails, but bunions can deal a blow to psychological well-being, too. The 2011 study found that the wider the angle at which participants’ bunions protruded outward, the worse their general health, mental health and social functioning. The researchers think the difficulty of finding cute yet bunion-friendly shoes could lower self-esteem and lead to social isolation, especially among older women.